M. Patrice Eiff: Fracture Management for Primary Care: 2nd EditionAnother "must-have." It features a fracture-by-fracture discussion of initial management, definitive management, which splint, which cast, when to re-examine, when to re-xray, and when to refer. Even if you choose not to provide definitive fracture care and casting, this book is still useful if only for the initial management section. (*****)

February 14, 2010

One of the biggest reasons arguing for colonoscopy over flex sig, in addition to the incremental value of being able to perform polypectomy at the time of diagnosis, was the prevention of right-sided lesions.

Thus, this observational study is quite concerning.

In a published case-control study from Canada, screening colonoscopy was associated with lower mortality from left-sided, but not right-sided, colorectal cancer (JW Gastroenterol Feb 20 2009). Now, in another study, investigators have reexamined the issue.

German researchers performed screening colonoscopy in 3287 people (age, 55); 586 had undergone screening colonoscopy within the previous 10 years (average, 5 years previously), and 2701 had never undergone screening colonoscopy. The prevalence of advanced left-sided neoplasia (cancer or advanced adenoma) — from splenic flexure to rectum — was significantly higher in the previously unscreened group than in the previously screened group (9% vs. 3%). However, the prevalence of advanced right-sided neoplasia — from cecum to transverse colon — was similar in the two groups (3%). Adjustment for age, sex, and family history did not change these associations.

Comment: Several studies suggest that screening colonoscopy affords less protection against proximal cancer than against distal cancer. Possible reasons include biological differences between proximal and distal neoplasias, and poorer visualization of the proximal colon due to operator factors or bowel preparation. Randomized trials of screening colonoscopy have not been performed; thus, we must resort to observational studies like this one — despite their limitations — to evaluate the procedure. As noted by editorialists, the findings raise provocative questions about whether the incremental effectiveness of colonoscopy — compared with flexible sigmoidoscopy — is sufficient to justify its greater risk and cost. (Allan S. Brett, MD)

Support for elements of the HCR bills http://ow.ly/1nC4rD (h/t A.Sullivan)

"Nate Silver shows that most of the individual parts of health insurance reform are very popular:"

"'What we see is that most individual components of the bill are popular -- in some cases, quite popular. But awareness lags behind. Only 61 percent are aware that the bill bans denials of coverage for pre-existing conditions. Only 42 percent know that it bans lifetime coverage limits. Only 58 percent are aware that it set up insurance exchanges. Just 44 percent know that it closes the Medicare donut hole -- and so on and so forth.'"

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